Underlying Assumption Two: Normal Exists, Normal Serves as an Important Starting Point, and Normal is Preferred

Now think back to the overall organizing structure of your master’s program, your graduate school classes, and even your textbooks. How did you earn your right to become part of the culture of speech-language pathologists?

First you learned about normal anatomy, physiology, and neurology; the normal phonetic structure of English; and typical child language development. Then you learned about the departures from normal that our profession views as disorders (or conditions, or at least potential problems; see Module 12). Finally, you learned about applying that information in clinical assessment, treatment, or management. You were required to pass tests, and then you were allowed and required to demonstrate your knowledge in your clinical practicum assignments, and then you were required to pass a final, high-stakes licensing examination.

Why was your education organized that way?

The usual answers are that we cannot understand what is abnormal or atypical until we understand what is normal or typical, and that we cannot make appropriate decisions about management unless we understand the nature of the disorder.

But dig a little deeper underneath those answers.

Why do we say that students cannot understand atypical until they understand typical?

Why do we say that clinicians cannot understand treatment or management unless they understand the normal referent and the departures from normal that the client’s current abilities represent?

Notice, if we keep playing this game, that your explanations will probably devolve into restatements of the conclusion: “Students cannot understand what is atypical until they have learned what is typical because the typical serves as the base for learning about the atypical.”

These beliefs make sense to us, because we are fish in water.

But if can manage to get outside ourselves and think about our thinking, we realize that starting with normal is not strictly necessary in any objective sense; it is merely an underlying cultural assumption of our profession. It is part of the cultural belief system that we have inherited as members of our profession, and it directly reflects the interests of our original 25 professional ancestors. As Duchan and Hewitt (2023) recently catalogued in some detail, this tendency toward ableism (or perhaps “normalism,” an assumption of and preference for that which is perceived as “normal”) was clear in the earliest writings of the 25 founders of the 1925 association that became ASHA — and the same view has continued to shape our profession, not only as a belief but as the underlying structure of our entire educational system and our entire approach to what we describe as basic clinical practice.

This cultural centering of normalcy has also shaped how we describe our profession to ourselves and to other people, throughout our profession’s history. In 1952, for example, multiple representatives of our profession worked together to develop a description of speech-language pathology to be used by the organizers of the MidCentury White House Conference on Children and Youth (ASHA Committee, 1952). In the ASHA Committee’s report to the Conference, children with speech disorders were described as one of the country’s “largest groups of seriously handicapped youngsters,” “urgently” in “need” of help. Persons with disabilities who “can speak normally” or at least “nearly so” were described as “tremendously different, as a rule... from [those] whose speech is gravely impaired,” and “the degree to which the family life may be carried on, in a normal fashion” was described as depending “very heavily upon whether the speech function of the handicapped individual is intact.” Even “relatively minor speech and voice defects” were described as disqualifying children from potential careers “such as teaching, [that] requir[e] good speech.”

Do you hear the underlying assumptions that are made explicit by these words? “Handicapped,” “impaired,” “normal,” “intact”; one of the more striking features of the ASHA MidCentury Report, to my reading as we approach the middle of the 21st century, is how casually and confidently the committee used such terminology. They seem to have been either utterly unaware of, or utterly convinced of, their underlying assumption that people who spoke or communicated in ways other than the ways that they assumed to be “normal” were “handicapped,” unable to participate “normally” in family life or in their chosen vocations, interfering with their entire families’ “normal” lives, and “urgently” in “need” of therapy designed to return them to an “intact” state.

Other examples of more or less explicit ableism or normalism are also obvious in our profession’s clinically-oriented journal articles or textbooks from different eras, including well after the 1950s. Our literature includes a continued emphasis throughout the decades on seeking “normal” speech and resonance for children who were born with cleft lip or cleft palate (e.g., Blakely & Brockman, 1995). And it’s not just history; well into the 21st century, our publications and textbooks continue to emphasize how exactly to elicit “correct” production of phonemes; the “need” to “suppress” and “eliminate” the use of “deviant” phonological patterns; and recommendations for the use of interventions that not only teach conversational skills but actually provide word-for-word scripts and specific goals for how an “appropriate” conversation must be structured, for clients we have diagnosed with social (pragmatic) communication disorder (see ASHA, n.d. and current as of this writing, about social communication disorder).

In these and many other examples, there is definitely some very clear evidence that our profession assumes that normal exists, that normal serves as a reasonable starting point, and that normal is preferred.

Has anyone ever questioned these assumptions? Yes, of course, and such questions also appear to be becoming more common in our professional culture, as you might have already been aware while reading this section.

As long ago as 1976, Clase drew on the constructs of stereotypes, social judgments, and continua that have shaped this website’s discussions as she asked “how different” speech must be to be considered “too different” and asked “To whom must it sound different?” (Clase, 1976, p. 51). She also questioned whether we “have the right” to make judgments about other people’s speech or to decide who needs treatment, given that such judgments can often be “subjective, arbitrary, and personal” (p. 51). She concluded by “questioning the ethics of... imposing our values on others and fostering a prescriptive position regarding acceptable speech behavior” (p. 55).

Later, similarly, in the first issue of the new American Journal of Speech-Language Pathology, Crais (1991) reviewed what had become by that time close to 10 years’ worth of work in the field of early intervention. Her article emphasized collaborating with parents and families, by which she meant supporting them as they seek to find the resources they want and develop the routines they find useful, given their reality as a starting point rather than given our values or our views about “normal” as a starting point. (We will discuss ethnographic interviewing, a specific clinical technique for helping ourselves understand clients and families in their own worlds, in Module 18.)

Most recently, as the constructs of ableism and neurodiversity have become common in society and in our profession (see Diedrich, 2023; Duffy, 1981), many other authors in ASHA’s journals and elsewhere have begun to argue explicitly in favor of rejecting the notion that any “normal” exists or can be preferred. They write about resisting ableism, accepting neurodiversity, and embracing our “ethical duty” as professionals to “acknowledge, respect, and value disability as a culture” and as an identity (Saia, 2023, p. 795; see also the collection of papers edited by DeThorne & Gerlach-Houck, 2023, among other examples).

The intersecting dimensions reflected here are complex, and we will return in the next module to thinking about the professional behaviors that might flow from our assumptions about “normalcy.” Before we get there, however, we need to address one more assumption that combines the constructs of professionals, clients, and normalcy with several other critical issues.